Obesity is more deadly than previously thought, but a nationwide survey shows that after rising for decades, rates have not increased for the first time in 30 years.

In the latest “F as in Fat” report, released annually by Trust for America’s Health and the Robert Wood Johnson Foundation, only one state, Arkansas, showed an increase in obesity rates while other states managed to keep their rates stable compared with the previous year. All of the 20 states with the highest obesity levels are located in the South or Midwest, with the exception of Pennsylvania. And for the first time in eight years, Mississippi is no longer the state with the highest adult obesity rate — Louisiana now holds that position with 34.7% of adults weighing in with a body mass index (BMI) above 30.

Once again, Colorado tops the list at the other end — as the state with the lowest obesity rate with 20.5% of its residents considered obese.

What helps Coloradans to stay at healthy weights, and what have states like Mississippi done to improve their standings? In Colorado, new laws require school districts to provide physical activity or recess during the day to help children burn off calories. That inspired other states — Arizona, Connecticut, Illinois, Indiana, Kentucky, Louisiana, Maine, North Carolina, North Dakota, Ohio and Tennessee — to pass similar laws.

Last year’s survey started to show that many states and cities were being proactive in addressing systemic problems contributing to childhood obesity. As TIME reported last year, New York City and Philadelphia, for example, took steps to include fresh foods at corner stores and require farmers’ markets to accept food stamps in order to encourage those in lower-income areas, where fresh produce is harder to find, to eat more fruits and vegetables. These approaches required involving entire communities to contribute to promoting exercise and improving the food environment, from retailers to vendors and schools.

Since children spent most of their days in school, changes in school-lunch menus are also contributing to lower obesity rates. States and school districts that started making these changes earlier have experienced the most success in getting children to eat healthier. In 2010, schools upped the food-quality standards for school lunches, and this year, the U. S. Department of Agriculture issued an update to nutrition standards for school snacks and drinks. The new regulations limit vending-machine snacks, also known as competitive snacks, to 200 calories. Any sodas or sports drinks sold in high schools must contain 60 calories or less in a 12-oz. serving. Elementary and middle schools can sell water, 100% fruit or vegetable juice, and low-fat or fat-free milk.

Public-health officials are hopeful that such measures will start to push obesity rates downward, and they have reason to be optimistic. Earlier last month, the Centers for Disease Control and Prevention reported decreases in obesity rates among low-income preschoolers. Between 2008 and ’11, 18 U.S. states and one territory reported declines in obesity rates among preschoolers. The findings were based on data of 12 million children ages 2 to 4, who were participating in federally funded nutrition programs. Childhood obesity rates in Florida, Georgia, Missouri, New Jersey, South Dakota and the U.S. Virgin Islands dropped by at least 1%, and while they did not experience declines, 20 other states and Puerto Rico managed to keep their current obesity rates from rising. Those improvements can be attributed to greater awareness of the dangers of obesity, as well as the effectiveness of public-health campaigns to encourage healthy eating habits beginning at young ages; some experts point to breast-feeding as a potential factor as well, since mother’s milk may contribute to lower obesity rates among toddlers.

While those trends are encouraging, the report also included some sobering news too. Obesity has become so entrenched throughout the U.S. that reversing the tide may require more intensive effort. In 2000, no state had more than 25% obese residents, but in the latest report, at least 20% of residents in every state were obese and 13 states had adult obesity rates that top 30%. And while overall obesity rates appear to have stabilized, the “F as in Fat” report shows that rates of “extreme” obesity, which was defined as having a BMI of 40 or more, increased by 350%.

That may explain why another recent report revealed another disturbing pattern among the obese. Researchers at Columbia University’s Mailman School of Public Health found that obesity was to blame for 18% of deaths among black and white men and women between ages 40 and 85, which is higher than the 5% mortality that previously attributed to being heavy.

In prior studies analyzing obesity rates, researchers lumped together those with high BMIs to show trends among the general population. The Columbia study, however, focused on how the risk for obesity-related deaths differed among the sexes, age groups and racial groups. A better understanding of how excess weight affects different subpopulations of people could lead to better ways of addressing weight loss among these groups and prevent unnecessary deaths. “We expect that obesity will be responsible for an increasing share of deaths in the United States and perhaps even lead to declines in U.S. life expectancy,” study author Ryan Masters says in a statement.

So in their analysis, Masters and his colleagues studied 19 waves of the National Health Interview Survey, in which a representative sample of U.S. adults of all ages answered a variety of questions about their lifestyle, including diet and exercise habits, and compared them with mortality records from the National Death Index between 1986 and 2006. The researchers found that the risk of obesity-related deaths increased with age, which suggests that the U.S. has yet to see the worst when it comes to mortality from excessive weight gain. “It stands to reason that we won’t see the worst of the epidemic until the current generation of kids grows old,” study author Bruce Link, a professor of epidemiology and sociomedical sciences at Columbia University, says in statement.

The new “F as in Fat” report found similar trends: obesity rates among baby boomers, for example, reached 30% in 41 states, whereas the rates among seniors over the age of 65 topped 30% in only one state, Louisiana. Those with less than a high school education and making less than $25,000 were also more likely to be obese compared with those who graduated or in higher-income groups.

Fortunately, these patterns are reversible, as states that have taken steps to address access to healthy foods have learned. If more fruits and vegetables are available in schools, for example, students will eat them, and cities that establish walking and biking programs also see more of its citizens becoming physically active. While obesity rates are still high, they appear to be stalling, and it’s important to build on that momentum. “In talking about this year’s report, we considered renaming it F as in Forward because we honestly believe real and lasting progress is being made in the nation’s effort to turn back the obesity epidemic,” the report’s authors write.

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well if skinny people would stop making fun of fat people when they do go outside and exersise then maybe they would go out and exersise, but people are just so dam mean, we also have an epidemic of mean people in this world.

I'm 26. When I was in elementary school, we had outdoor recess twice every day in addition to P.E. Our outdoor recesses were a 15-minute break in the morning and a 15-minute break in the afternoon. As kids, we enjoyed playing outside. I'm sure our teachers also enjoyed that we burned off all of our energy and paid more attention when we came back inside. However, I never remember our school lunches being very healthy or appealing. Lunch was usually a tiny slice of a soggy pizza, or chicken nuggets and boiled, canned corn. They were usually about $1.70/each. They were disgusting though, so my mom usually made me a sandwich, fruit, chips or celery sticks, and a juice box. Now, even a packed lunch like that wouldn't pass at some schools.

Second, since obesity is a disease, medical professionals will now develop further root cause analysis tools, treatment plans, and prevention plans (so it does not return again).

Third, to deal with obesity/being over-weight (the two are different), affected individuals should engage in the following activities:

1) Walking for 30 min. to 1 hr./day.

2) Eating well-portioned meals (ratio of 2-3 servings of protein to 1 serving of carbohydrates) between 5-6 times/day every 2-3 hours. That prevents wide swings in blood sugar levels, which can cause diabetes later on in life.

We no longer eat food that nature produced 100 years ago. Why? It is not good for business. Our political leaders and laws are 100 % committed to this principal. When we get back to eating wholesome food; the type that has more to do with the quality of life rather than shelf life. We will do fine. It is 70% of the problem.

Our immune system is intelligent. It is there to keep us alive; for better or for worse. When we eat man made or "dead food" from boxes, it trusts us. If it does not recognize it, it assumes there is a good reason and "stores" these man made nutrients; now called toxins. The immune system then notifies your brain that it is still hungry for the real thing it was expecting. Of course we go and eat more of the same junk. Poor immune system! That and not stress causes binge eating. Natural unt-ampered with food, nourishes us in a holistic way. It brings more useful meaning to comfort food.

I have heard good things about this new diet pill called Belviq. I noticed someone else left a comment in regards to this pill. I have been tempted to try it myself. It works a bit differently then others. It makes you feel full and people are binge eating less while on this. Anyone else try this thing yet??

So people have stopped getting fatter than the whale size they are now . Those states with the fattest people also have large black populations and blacks have a hugh percentage of their population that are fat.

I am not interested in what other people believe, i.e. that all fatness is unhealthy and dangerous. I am not interested in studies which purport to prove things with their trumped up statistics. I only want purely objective coverage of the NEWS. This is not news. This is not objective. I claim otherwise, and I need no proof to do so, because it is only given as a belief. Which is what EVERYONE else who does not have proof should do.

I remember a couple of years ago Michele Obama, our First Lady was making recommendations for better diets in schools, and get moving exercise for kids. She planted a garden on the WH grounds with the help of children. I also remember the criticism from the right wing that they didn't want government dictating how they fed their children. It seems that Michele's program was a great success. And look at the benefits. Healthier kids, that can do better in school along with fewer health problems.

LA and MS have 32% and 37% black population, most other stats are similar. Older people across the board are 11% in CO and almost 13% in LA and MS. Laws may have helped, maybe not on this issue. Who's fat, kids, middle age, old, or across the board? Laws don't cure that.

"Mississippi is no longer the state with the highest adult obesity rate — Louisiana now holds that position."

... and what have states like Mississippi done to improve their standings?
In Colorado, new laws require school districts to provide physical
activity or recess during the day to help children burn off calories. That inspired other
states — ... Indiana, Kentucky, Louisiana... to pass similar laws."

Fat America!!!! Eat nothing but garbage food from all the fast food I would not even call them restaurants because they do NOT cook except heat theCRAP in the micro wave and serve and shows it very well!!!!!! Most over weight people in the World!!!

while healthier school meals is a good idea i don't think it will help cure obesity. 3 meals a day is 21 a week only five will be at school and none during summer break not enough to make a difference.

Lots of thing I see going on. Many parents are too afraid to let their kids play out of their sights these days. When I was a kid in the 70's kids would run all over the neighborhood,and only come home (or go over their friend's house) for lunch. America today has a lower crime rate than the 70's 80's of 90's but local news has scared parents so much, that they want kids to stay inside. Queue the video game industry keeping kids in their homes. Playing inside not only leads less exercise, but it also has kids closer to snacks and food while they are playing.

I don't know if I agree with people saying that food today is less healthy then in the 70's in reference to ingredients, but most people do eat less home cooked meals, more kids are allowed to eat and watch TV (and in their rooms) something socially frowned on in the 70's. Home cooked meals are normally healthier than prepared meals, and eating in your bedroom has been shown to lead to bad eating habits later in life.

I also think that when I was a kid it was more difficult for a parent to get their kid out of gym class. Too many parent caved into their kids and gave them free passes out of class in the decades after my youth. Budget cuts also lead to many schools cutting gym class.

I work in a high tech engineering environment and the men actually read the labels on everything and won't eat things that have weird ingredients. I brought in hotdogs one day for my lunch and 3 guys asked me if they were uncured. It isn't just a lifestyle of exercising at high altitudes but a real food awareness. People here are really proud to be healthy. They brag about their workouts, hikes, and bike rides. We share healthy recipes all the time. Lots of folks at work get Door to Door Organics deliveries (including myself), only shop and buy organic foods or use a CSA farms. Home made food is big, bring in home made cookies and they disappear; bring in store bought and they sit for hours. You also have to realize that the 20% obesity would include all the military from other states - Colorado Springs alone has 5 military establishments. Our environment is also one that even if it is hot out, it is low humidity and much easier than the southern states to get out and do things in. We have showers at work for the people who work out at lunch time, we have secure indoor parking for the people who ride their bikes to work, we have annual blood screenigs, if wanted for free for blood sugar, BP, cholesterol, weight and BMI. It really is a state lifetyle, maybe from the old tree-hugger days LOL

@ElaineMays I don't think it was a great success just because fat people have stopped getting even fatter than they now are. The republicans will pick on anything just because it's the democrates saying it, which made them look like idiots. It was a good try on her part and it helped that she lost a little weight as she was fat also.

@BillMyers It changed mine, after 20 months, I got off the meds, I lost a 100 pounds, my arthritis is much easier to take. Joe Cross saved my life. I grew up in central PA, meat and potatoes, I'm 61, if I can do it, anyone can. I wish you all good health. Now let's get tax breaks for Organic Farmers!

@DP That anecdotal observation by you is contradicted by the fact that people with lower incomes (including those out of work) tend to eat less healthy:

Junk food and fast food are more affordable than healthy fruits and vegetables. Adults that are home don't necessarily cook meals for their families. Unhealthy eating has strong cultural and lifestyle influences. That's why people in the South and Midwest are heavier. Their regional foods include lots of fat, red meat, and starches. Meat & potatoes with a can of Coke is a standard dinner in the Midwest. Don't get me started on how Mountain Dew is the #1 poison in the South!

@gmspeters It's got nothing to do with racial demographics. As you stated yourself, those states have a minority black population. Therefore, according to your logic, its the whites who are responsible for the obese numbers.

Rather, its a regional cultural problem. The typical Southern diet is heavy on fat, red meat, and starches. That's true for whites and blacks. Bacon fat used for frying eggs, drinking sugary sodas all day long, the lack of fresh fruit in their diet, potato chips, etc.

@ScottLong If you are more likely to be obese if your household income is <25k/year then many of these kids are eating 2 meals a day at school: breakfast and lunch. So 10 out of 21 meals could make a huge difference.

Your middle paragraph there hit the nail on the head! The eating in front of the TV, eating in the bedroom. People become zombies just smearing their fork around the stuff on their plate or easily reaching into the chip bag every minute for hours at a time. When I was a teenager my parents weren't really into the whole dinner table concept anymore - I think they had had enough family time to last forever. I let myself go feral when it came to eating when I was in high school. I hate eating in my bedroom, on the couch, etc. I prefer to sit at the kitchen table or counter, have my meal and move on with my day. Too many people eat in bed too. That's just plain wrong.

Congrats! I had a similar journey. Lost 85lbs, stopped taking 12 different pills a day, became a vegan.... yadda yadda yadda.... No, it's not easy and yes I feel much better now. I never feel 'yuckie' after meals and never, ever crave sugar, cheese, meat -- nothing at all. Fresh food from Mother Earth simply cannot be beat. Have a groovy day!

@bocca@DP If you can afford soda, don't cry about how you can't afford healthy food.

Many fruits and vegetables are really not that expensive - you just have to know which ones to buy. Bananas are less than a quarter each. A head of broccoli, enough for a serving for a family of 3-4 is about a dollar or two. Green beans are similar. A head of romaine lettuce is about a dollar (well three is about $3-4). Tomatos, onions, celery, carrots, apples, are all pretty cheap. Yeah, avocados, peppers, strawberries are expensive. So don't eat those, or buy them sparingly and/or when on sale.

A big mac and french fries costs more than $5. If you have a family of 4, that's $20 for one meal, and that's assuming you don't order a soda, which almost everyone does. You can make a LOT of meals cheaper than that at home. Heck, you can make hamburgers and green beans, a similar meal and one that doesn't take much time. At my local store 20 patties costs $15, so each patty is less than a dollar. A package of 8 burger buns is about $4, so 50 cents per bun. Green beans are $2/lb, and a pound would feed a family of 4, so that's 50 cents per again. Don't actually want to eat quite that healthy? A bag of bakeable french fries is also $2. We're up to a grand total of $2/meal. Add some cheese and condiments and MAYBE you get to $3 each. How again is it cheaper to eat at McDonalds? If you're willing to eat a different type of meal, you can get even cheaper by eating pasta, beans and rice, homemade soups, sandwiches, etc.

People don't cook because they don't want to. Okay, but don't pretend that it's because fast food is actually cheaper.

My grandmother was from the south and bacon fat was her secret base for all of her best recipes. Don't get me wrong, that woman could make some really good dishes...but if I knew then what I know now, I would've opted for just the salad and the vegetables on my plate.

@whatsgoingon?freedom@jthira If I see a restaurant that says it serves "family style" or "country cooking" or anything remotely looking like a chicken fried steak, it pass it by. They're all heavy in salt and fat and what vegetables they do serve are cooked with bacon fat or lard and have no nutritional value.

If i do have to eat out, I'll spend the extra $10 and go to a quality restaurant with an actual trained chef , quality ingredients, and smaller portions. And drink water or wine...no soda pop-ever.